SLP G Codes - Life Care Therapy

1 LifeCare Therapy Services Reh abil ita t ion Therap y and D ise ase Man ag em en t Functional G Codes / Severity Modifier Conversion When to Assess G- code : At start of care/ Therapy evaluation At each progress report / once every 10 treatment visits At time of a substantial change in condition (Re- Certification) At time of discharge To end reporting of one functional limitation and to begin reporting of a different functional limitation If the patient is seen for only one visit and further services are either (1) not medically necessary or (2) will be rendered by another provider, then all 3 Codes are to be reported. Guidelines for Selecting the Severity Modifier: Use the severity modifier that reflects the score from a functional assessment tool or other performance measurement instrument If multiple tools are used, clinical judgment is used to combine these results to determine a functional limitation percentage How the severity modifier was selected must be documented in the clinical record When to Use the Other Functional G- Codes A functional limitation is not defined by one of the categories; Therapy services are not intended to treat a functional limitation ( , unstable fracture or lymphedema) A composite or global functional score is used which does not clearly represent a functional limitation defined by one of the four functional categories American Speech-Language-Hearing Association 2013 Medicare Fee Schedule for Speech-Language Pathologists Appendix 2: G- Codes & Modifiers for Outcome Reporting on the Claim Form Table 4.

2 G- Codes G- Codes Functional Limitation & Status Swallowing Swallowing functional limitation, current status at time of initial Therapy treatment/episode outset G8996. and reporting intervals Swallowing functional limitation, projected goal status, at Therapy episode outset, at reporting G8997 intervals, and at discharge or to end reporting Swallowing functional limitation, discharge status, at discharge from Therapy /end of reporting on G8998. limitation Motor Speech Motor speech functional limitation, current status at time of initial Therapy treatment/episode G8999. outset and reporting intervals Motor speech functional limitation, projected goal status, at Therapy episode outset, at reporting G9186. intervals, and at discharge or to end reporting Motor speech functional limitation, discharge status at discharge from Therapy /end of reporting G9158. on limitation Spoken Language Comprehension Spoken language comprehension functional limitation, current status at time of initial Therapy G9159.

3 Treatment/episode outset and reporting intervals Spoken language comprehension functional limitation, projected goal status, at Therapy episode G9160. outset, at reporting intervals, and at discharge or to end reporting Spoken language comprehension functional limitation, discharge status at discharge from G9161. Therapy /end of reporting on limitation Spoken Language Expression Spoken language expression functional limitation, current status at time of initial Therapy G9162. treatment/episode outset and reporting intervals Spoken language expression functional limitation, projected goal status, at Therapy episode G9163. outset, at reporting intervals, and at discharge or to end reporting Spoken language expression functional limitation, discharge status at discharge from Therapy /end G9164. of reporting on limitation Attention Attention functional limitation, current status at time of initial Therapy treatment/episode outset G9165. and reporting intervals Attention functional limitation, projected goal status, at Therapy episode outset, at reporting G9166.

4 Intervals, and at discharge or to end reporting Attention functional limitation, discharge status at discharge from Therapy /end of reporting on G9167. limitation . All CPT Codes and descriptors are copyright 2012 American Medical Association 15. American Speech-Language-Hearing Association 2013 Medicare Fee Schedule for Speech-Language Pathologists G- Codes Functional Limitation & Status Memory Memory functional limitation, current status at time of initial Therapy treatment/episode outset G9168. and reporting intervals Memory functional limitation, projected goal status, at Therapy episode outset, at reporting G9169. intervals, and at discharge or to end reporting Memory functional limitation, discharge status at discharge from Therapy /end of reporting on G9170. limitation Voice Voice functional limitation, current status at time of initial Therapy treatment/episode outset and G9171. reporting intervals Voice functional limitation, projected goal status, at Therapy episode outset, at reporting intervals, G9172.

5 And at discharge or to end reporting Voice functional limitation, discharge status at discharge from Therapy /end of reporting on G9173. limitation Other Speech-Language Pathology Functional Limitation Other speech language pathology functional limitation, current status at time of initial Therapy G9174. treatment/episode outset and reporting intervals Other speech language pathology functional limitation, projected goal status, at Therapy episode G9175. outset, at reporting intervals, and at discharge or to end reporting Other speech language pathology functional limitation, discharge status at discharge from G9176. Therapy /end of reporting on limitation Table 3: G- code Modifiers Modifier Impairment Limitation Restriction NOMS Level CH 0% impaired, limited or restricted 7. CI At least 1% but less than 20% impaired, limited or restricted 6. CJ At least 20% but less than 40% impaired, limited or restricted 5. CK At least 40% but less than 60% impaired, limited or restricted 4. CL At least 60% but less than 80% impaired, limited or restricted 3.

6 CM At least 80% but less than 100% impaired, limited or restricted 2. CN 100% impaired, limited or restricted 1.. All CPT Codes and descriptors are copyright 2012 American Medical Association 16. American Speech-Language-Hearing Association 2013 Medicare Fee Schedule for Speech-Language Pathologists Appendix 3: Case Scenarios for Outcome Reporting on the Claim Form Please refer to the sample CMS 1500 claim form ( Forms/ [PDF]) and Appendix 2 for G- code (p. 15) and Modifier (p. 16) descriptions. Scenario 1: Patient Seen for One Functional Limitation Patient presents with a history of CVA and was referred because of severely reduced speech intelligibility. Language and cognitive function are normal. The patient can produce short consonant-vowel combinations, but is rarely intelligible in context. Plan of care is for 12 visits, with goal for intelligibility in routine activities with familiar and unfamiliar partners. Functional limitation: Motor Speech (G- code : G8999), NOMS Level 2 (Modifier: CM).

7 Projected goal: Motor Speech (G- code : G9186), NOMS Level 5 (Modifier: CJ). Reporting on the Initial Claim Box (Procedures, Services, or Supplies). o Line 1: CPT/HCPCS: 92506, Modifier: GN. o Line 2: CPT/HCPCS: G8999, Modifier: GN, CM (Current status of motor speech limitation). o Line 3: CPT/HCPCS: G9186, Modifier: GN, CJ (Projected goal for motor speech limitation). Reporting on the Claim for Visits #2-#9. Box (Procedures, Services, or Supplies). o Line 1: CPT/HCPCS: 92507, Modifier: GN. o No additional outcome/goal reporting Reporting on the Claim for Visit #10 (Reporting must occur at least once every 10 treatment days). Status: Patient has progressed to being able to produce short phrases intelligibly with moderate cuing (NOMS. Level 4). Box (Procedures, Services, or Supplies). o Line 1: CPT/HCPCS: 92507, Modifier: GN. o Line 2: CPT/HCPCX: G8999, Modifier GN, CK (Current status of motor speech limitation). o Line 3: CPT/HCPCS: G9186, Modifier: GN, CJ (Projected goal for motor speech limitation).

8 Reporting on the Claim for Final Visit (Patient discharged from plan of care). Status: Patient intelligible in routine activities (NOMS Level 5). Box (Procedures, Services, or Supplies). o Lines 1 2: CPT/HCPCS: 92507 and/or 92506 (see note below). o Line 3: CPT/HCPCS: G9158, Modifier: GN, CJ (Status of motor speech limitation at discharge). o Line 4: CPT/HCPCS: G9186, Modifier: GN, CJ (Status of projected motor speech goal at discharge=goal met). ASHA Note: Final visit may include treatment (92507) and/or re-evaluation (92506). The Medicare Benefit Policy Manual states that a re-evaluation may be appropriate prior to planned discharge for the purpose of determining whether goals have been met, or for the use of the physician or the treatment setting at which treatment will be continued.. All CPT Codes and descriptors are copyright 2012 American Medical Association 17. American Speech-Language-Hearing Association 2013 Medicare Fee Schedule for Speech-Language Pathologists Please refer to the sample CMS 1500 claim form ( Forms/ [PDF]) and Appendix 2 for G- code (p.)

9 15) and Modifier (p. 16) descriptions. Scenario 2: Patient Seen for Multiple Functional Limitations Patient presents post CVA with expressive and receptive aphasia. The patient is able to follow simple directions with maximal cues, verbal attempts to speak are not meaningful or accurate, and consistent moderate cues are necessary for safe swallowing. The speech language evaluation reveals severe expressive and receptive language scores, and the swallowing evaluation indicates a moderate-severe swallowing deficiency. Functional Limitations: o Swallowing (G- code : G8996), NOMS Level 2 (Modifier: CM). o Spoken Language Comprehension (G- code : G9159), NOMS Level 2 (Modifier: CM). o Spoken Language Expression (G- code : G9162), NOMS Level 1 (Modifier: CN). CMS allows the reporting of one functional limitation at a time. For this case, it was determined that Swallowing would be reported initially. Projected goal: Swallowing (G- code G8997), NOMS Level 6 (Modifier: CI). Reporting on the Initial Claim Box (Procedures, Services, or Supplies).

10 O Line 1: CPT/HCPCS: 92610, Modifier: GN. o Line 2: CPT/HCPCS: 92506, Modifier: GN. o Line 3: CPT/HCPCS: G8996, Modifier: GN, CM (Current status of swallowing limitation). o Line 4: CPT/HCPCS: G8997, Modifier: GN, CI (Projected goal for swallowing). Reporting on the Claim for Visits #2 #9. Box (Procedures, Services, or Supplies). o Line 1: CPT/HCPCS: 92507, Modifier: GN. o Line 2: CPT/HCPCS: 92526, Modifier: GN. o No additional outcome/goal reporting Reporting on the Claim for Visit #10 (Reporting must occur at least once every 10 treatment days). Status: Patient has progressed, swallowing is safe, but usually requires moderate cues to use compensatory strategies (NOMS Level 4). Box (Procedures, Services, or Supplies). o Line 1: CPT/HCPCS: 92507, Modifier: GN. o Line 2: CPT/HCPCS: 92526, Modifier: GN. o Line 3: CPT/HCPCX: G8996, Modifier GN, CK (Current status of swallowing limitation). o Line 4: CPT/HCPCS: G8997, Modifier: GN, CI (Projected goal for swallowing). Scenario continued on next page.